Elimination of Fraud and Abuse in Health Care - Part 3

Waste, fraud and abuse in healthcare stops				workshops,seminars and training programs should
customers to have economical health facilities and				be held in schools in order to educate children.
it ultimately results in decline of quality as well. The				Finally the government has to effectively use the
United States of America's one of the biggest				electronic and print media and other ways to
challenge is to come up with the strategy and				create awareness among people.
ideas which help people having health facilities with				Problem Area
quality, coverage and most importantly				The healthcare costs are escalating and the health
economical. It is explained in "Elimination of fraud				insurance have gone up too in the last few years,
and abuse in health care "part 2 that the				almost doubled with mounting 3.7 times faster in
customers dealing with healthcare is out of their				comparison to the salaries of employees. About
reach each year and their pockets do not allow				100,000 Americans die from medical errors in
them to have quality and economical health.				hospitals every year1. The personal bankruptcies
President Obama is appreciating and welcoming				are greater than ever due to lack of affordable
"ideas which can cut the cost, bring quality, reduce				health. Over 45 million Americans, including over 8
waste, fraud and abuse, last but not the least				million children not having health insurance. 80% of
gives customer choice in healthcare.				the working families are uninsured. Intensifying
One of the focal points is to bring innovation in				health care costs are making it extremely
healthcare and develop a system which can bring				intricate for employers, particularly small
the mentioned constraints in healthcare. For that				businesses, to endow with health insurance to
matter there is a need to take a look in what the				their workers.
Obama's healthcare reform plan is?				The basic problem is that until or unless a plan is
Barack Obama's Health Care Reform Plan				not executed, things will not be changed. They will
President Obama envisions the healthcare system				remain static. The claim that every American
so perfect that not even a single American				family will save $2,500 will be a dream, if there is
suffers from healthcare. He puts emphasis on the				no proper strategy and its implementation. There
reforms and his plan estimated cost is around $50				has to be a pro active procedure to fight with
to $65 billion. The key factors of Obama's interest				these issues. The nucleus of the strategy is to
are:				eliminate waste, fraud and abuse in healthcare. As
1. Quality, Affordable & Portable Health				it is discussed before that there are a lot of
Coverage for All.				statements and thirst for the enhanced healthcare
2. Modernizing The U.S. Health Care System To				system but nobody talks about the central point.
Lower Costs & Improve Quality				By just saying "reforming the market structure"
3. Promoting Prevention & Strengthening				or "Adopting state-of-the-art health information
Public Health.				technology system" and "Ensuring that patients
One of the core aspect of this plan is the claim				receive and providers deliver the best possible
that every family will save approximately $2,500				care" the healthcare system would not improve.
each year. The plan caters a Health information				One has to come up with the practical approach
technology investment aimed at dropping needless				and a "system" which can actually deal with these
expenses that result from avoidable errors and				problems.
ineffective paper billing systems. It will also help				Steps to be taken to avoid fraud and abuse
preventing and organizing of persistent				The "system" has to be flawless in order to
circumstances. The preparation is required to raise				achieve what is promised. The Americans are
insurance industry competition and reduce				going through a difficult phase of recession. It is
underwriting costs and profits in order to				the prime responsibility of the state to deliver
decrease insurance overhead. The health				what is pledged. There are some vital steps to be
insurance should be universal which will diminish				taken to ensure the paramount quality.
spending on uncompensated care.				- Any one who is involved in care providers, the
The critics say that there is cost shift rather than				flow of information has to be accurate.
cost reduction in this plan. Obama's stresses over				- This is absolutely vital to encounter Date
creating another program just like Medicare or				Reporting System in place which can accumulate
under- 65 age is itself a costly thinking. He also				or transfer such information that can reduce the
wants to empower government programs				fraud and abuse.
Medicaid and SCHIP. Obama makes investments in				- The existing encounter Data Reporting Systems
health information technology a significant element				are creating insufficient information to provide any
of his cost control strategy. This is the point of				means for the reduction of potential fraud and
discussion. The only way to cope up with all these				abuse.
issues is to significantly use the technology. In				- There is a strong need of making
order to improve quality Obama has planned to				enhancements or addendum to the existing ERRS.
take steps which can produce results. It includes				The very first problem occurs when the
disease management programs, coordinated care,				measurements taken to avoid fraud and abuse
transparency about cost and quality of care,				are considered to be satisfactory. The CMS has a
improved patient safety, aligning incentives for				lot more potential to recover as they are
excellence, comparative effectiveness reviews,				recovering currently. It is discussed thoroughly
and reducing disparities in health care treatments				that what is fraud and abuse? And how it occurs?
for the same illness.				A unanimous plan of the strategy builders is to
The three essential points to reduce inefficiency				have precautionary measures to avoid fraud and
and abuse and improve healthcare quality are:o				abuse. When the fraud and abuse actually takes
Adopting state-of-the-art health information				place then the need of identification is required. It
technology system.o Ensuring that patients				is considered that the identification of improper
receive and providers deliver the best possible				payments is reasonable. Here is the problem; the
care, including prevention and chronic disease				CMS (Centers of Medicare and Medicaid services)
management services.o Reforming the market				came up with RACs (Recovery Audit
structure to increase competition; and offering				Contractors) and they were able to identify only
federal reinsurance to employers to help ensure				0.3 percent ($ 1.03 billion) of the claims received
that unexpected or catastrophic illnesses do not				whereas the total of $317 billion Medicare claim
make health insurance unaffordable or out of				payments available for review. Just because the
reach for businesses and their employees.				amount of recovery is high RACs are considered
The 3rd point of the Obama's plan is to Promote				to be satisfactory but the percentage o recovery
Prevention & Strengthening Public Health. For				is extremely near to the ground.
that matter he thinks, employers, school systems				References
the medical and public health workforce, and				1. Linda T. Kohn, Janet M. Corrigan, and Molla S.
federal and state and local governments have to				Donaldson, Editors; Committee on Quality of
play their role. The employers have o offer onsite				Health Care in America, Institute of Medicine
clinical preventive services such as flu vaccinations,				(2000). To Err is Human. Washington, DC: National
hygienic food in cafeterias etc. the				Academy Press.

Integrail

Elimination of Fraud and Abuse in Health Care - Part 3